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Thread: 38746

  1. #1

    Default 38746

    AAPC: Back to School
    The CPT book doesn't state what primary procedure codes this should be billed in conjunction with. I have a surgeon who performed a Mitral valve replacement-33430..... who also performed a Thoracic lymphadectomy because the patient had a worrisome lung mass and lympadenopathy. I billed 33430 and 38746...... one paticular insurance is denying 38746... stating the primary procedure code was not billed. They will not tell us what codes it can be billed with. I am unsure if I billed this incorrectly, but I felt since both surgeries took place in the thoracic cavity, through the same incision... that 38746 could be billed.


  2. #2
    Join Date
    Apr 2007
    Central Philadelphia chapter


    Your coding is correct. I would appeal the rejection.

  3. #3

    Default add-on codes

    Medicare has a list of "stand Alone" (ZZZ codes) that indicates what add-on codes can be billed with what primary codes. for 38746 it shows as follows:
    32440-32488, 32501-32525, 32663, 39010, 43101, 43108, 43112-43113 and 43117-43124.

  4. #4
    Join Date
    Apr 2007

    Default add on codes

    I know this is an older post but where did you find the "list" for what codes the add on codes are linked with I am having major issues with this at the moment.
    thanks in advance if you see this post

  5. #5

    Default Primary Codes related to add-on code 38746

    As an "add-on" code, 38746 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. "Add-on" codes describe additional intra-service work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as a stand-alone code. Report 38746 in conjunction with 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504, or 32505. When performed, mediastinal lymph nodes include subcarinal, paraesophageal, and inferior pulmonary ligament on both sides; right side also includes the paratracheal and left side also includes the aortopulmonary window. Mediastinal and regional lymphadenectomy performed via thoracoscopy (VATS) is reported with 32674.

  6. #6

    Cool Add on Codes

    The primary codes that can be billed with add on codes are usually listed just below the add on code in the CPT manual. (posted many years later)

  7. #7


    I have been looking for clarification on these codes and what needs to be documented in order to bill them. My understanding is on the right, documentation needs to show removal of Level 2 (upper paratracheal), Level 4 (lower paratracheal), Level 7 (subcarinal), Level 8 (paraesophageal) and Level 9 (inferior pulmonary ligament), when each are present. On the left side documentation requirements are Level 7 (ap window) Level 7 (subcarinal), Level 8 (paraesophageal) and Level 9 (inferior pulmonary ligament), when each are present.

    Is this right?

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